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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 43. Go back in thread:
Posted by Hugh on November 16, 2014, at 20:35:06
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Hugh, posted by Chris O on November 15, 2014, at 14:50:04
I'm sorry to hear that your rTMS technician makes you feel judged. Whether it's projection or the real thing, it's a lousy feeling.
A couple Babblers who did rTMS didn't respond until about the 20th session. Some responded much earlier and some never responded. Since your psychiatrist seems to be open to trying anything, if and when you decide to treat the right side, rTMS appears to be significantly more effective if priming stimulation is used. This means a brief exposure to 6 hertz, followed by a much longer exposure to 1 or 2 hertz. Here's an article about it:
Posted by Chris O on November 16, 2014, at 23:15:31
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by Hugh on November 16, 2014, at 20:35:06
Hugh:
Thanks for that information. I will definitely mention it to my psychiatrist the next time I see him. I actually feel like I am getting some benefit out of rTMS already, though it's like "robust tepid," or something like that.
Another thing that bothered me after my last session (my 14th) was that the woman in charge of the rTMS machine had not gotten approval for my next 16 sessions (insurance only approved 16 so far). So, I told her that even though I was not sure I was experiencing robust improvement yet, I wanted to make certain I got approval for the next 16. She (in my eyes at least) huffed off and said, "Chris, we'll work on getting approval." I know I can be annoying with my anxiety, but if I do not get approval, I will definitely be having words with the psychiatrist about his letting this young lady be in charge of my care. That is going to piss me off royally if I go in there tomorrow or Tuesday and do not get approved for more sessions.
Chris
Posted by phidippus on November 18, 2014, at 17:11:06
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 15, 2014, at 22:30:38
Have you considered deep brain stimulation or Vagus Nerve Stimulation?
Eric
Posted by Chris O on November 19, 2014, at 0:19:50
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 18, 2014, at 17:11:06
Eric:
Well, not really. Having a device implanted in my brain horrifies me, though I guess if it caused miraculous recovery, allowing me to take complete authority and control over my life--career, property, fulfilling personal relationships, the works--I'd consider it. Short of that, I don't think so. What about you?
Chris
Posted by phidippus on November 19, 2014, at 12:49:30
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 19, 2014, at 0:19:50
Nah, I have a cocktail that's working for me. Though I was assessed for DBS a couple years ago.
Eric
Posted by Chris O on November 19, 2014, at 15:20:40
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 19, 2014, at 12:49:30
Eric:
Now that you mention it, I think I remember you talking about that. Glad to hear that your cocktail is doing the trick. My p-doc is having a peer-to-peer review with my insurance company to see if I get to continue rTMS for another 16 sessions. I think it's doing something positive, so I'd at least like to continue this current trial before moving on to something else.
Chris
Posted by phidippus on November 20, 2014, at 15:06:31
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 19, 2014, at 15:20:40
My cocktail is ridiculous, however. Check it out:
Lithium 1050 mg
Carbamazapine 800 mg
Zonegran 200 mg
Geodon 160 mg
Luvox 100 mg
Vyvanse 70 mgSo what kind of benefit do you perceive you are getting from the rTMS?
Eric
Posted by Chris O on November 20, 2014, at 17:05:43
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 20, 2014, at 15:06:31
Wow, that's quite the cocktail. But if it works, and the side effects are not bad, then that's awesome. My psychiatrist's flexibility and lack of pushiness have suited my fear-based personality well, but I sometimes wish he'd dole out some poly-pharmaceutical suggestions, in a compassionate way. He's definitely suggested adding Abify multiple times when I was taking an SSRI, but I always chicken out after holding on to the samples for a couple of months.
Just curious (and feel free not to answer if this is too personal): Are you able to work full time, make enough money to survive on your own, and manage your life well with this combo? That's really what I'm searching for. Right now, I just get too overwhelmed when faced with the prospect of managing finances, etc.
Anyway, the rTMS is definitely having a noticeable (mildly) antidepressant effect on me. I have found it much easier to talk to people the last few weeks; I am less codependent about their reactions to me (I am hypersensitive to people's facial expressions and moods), I feel less guilty about asserting myself (which for me just means talking to people), and I have slightly more energy. Sleep has improved a bit, though my sleep apnea sometimes makes it hard to know how much. I don't think it's placebo, but I wouldn't rule that out completely, as I am getting some attention everyday, and I am hoping/supposed to be "getting better" That in itself is a powerful elixir.
Also, my insurance did approve 15 more sessions, and I had more first one in that group today. The doctor advised doing a bilateral rTMS this round (half the 40 minute session on the left DLPFC, half on the right DLPFC), but I have to say, I felt worse after this treatment (I was feeling better before). And since the doctor wasn't there, and it is just the lady in the office who does the rTMS, I wasn't sure if she even did the treatment correctly. Not sure if it's supposed to be low frequency rTMS on the right side (many studies used low frequency rTMS for the right DLPFC treatments, high frequency for the left DLPFC), or if it even matters. As to your earlier comment (that you can't believe rTMS is even considered a valid treatment), there do seem to be too many variables to even know what's going on. My feeling thus far is that there is an overall lack of professionalism in the administration of rTMS, but ... I have too many thoughts about this topic to share right now.
Anyway, sorry for babbling. Hope you are doing well. Thanks for interacting with me.
Chris
Posted by phidippus on November 20, 2014, at 17:34:08
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 20, 2014, at 17:05:43
>Are you able to work full time, make enough money to survive on your own, and manage your life well with this combo?
This combo is brand new with the addition of the Carbamazapine and Zonegran as of the beginning of the week, but previous I was functioning just fine on the lithium, luvox, geodon and vyvanse. It just never fails that about a month into treatment with an ssri I become manic. So we had to add the carbamazapine. The Zonegran is just for fun-see if it improves mood and helps my ocd.
I was working a job part time-I started back in July. I just quit to focus on school. So I guess you can say I'm pretty functional (school and work would be too much, I will admit).
>but I sometimes wish he'd dole out some poly-pharmaceutical suggestions, in a compassionate way.
What are you taking and what is your diagnosis?
>I have found it much easier to talk to people the last few weeks
Interesting you would first measure the success of your treatments by the way you interact with people.
>my sleep apnea sometimes makes it hard to know how much.
I have sleep apnea too.
>it is just the lady in the office who does the rTMS, I wasn't sure if she even did the treatment correctly.
That's scary. Is she trained?
>Anyway, sorry for babbling. Hope you are doing well. Thanks for interacting with me.
You aren't babbling and I'm doing well. Interacting with you is a pleasure. You are my friend.
Eric
Posted by mogger on November 20, 2014, at 17:39:41
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 20, 2014, at 17:34:08
Keep us posted Eric regarding Zonegran and hopefully being effective for your ocd. Did you ever try topamax for ocd?
mogger
Posted by phidippus on November 20, 2014, at 18:13:10
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by mogger on November 20, 2014, at 17:39:41
Yes I did. Topomax was hilariously bad for my OCD. I became afraid that I wasn't going to be able to stand my inner voice anymore so I became anxious everytime I 'heard' my inner voice. I became a total nervous wreck on Topomax.
Eric
Posted by mogger on November 20, 2014, at 18:16:12
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » mogger, posted by phidippus on November 20, 2014, at 18:13:10
That's awful! Sorry to hear it. Perhaps I won't bring it up when I see my Dr. tomorrow!
Mogger
Posted by Chris O on November 20, 2014, at 18:50:40
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » Chris O, posted by phidippus on November 20, 2014, at 17:34:08
Hey, Eric:
My diagnosis? That's a good question. I would say I'm on the PTSD/GAD/OCD/agoraphobia axis--chronic worrying, unable to feel like I have escape my childhood with my mother, worrying that people want to harm me (such as poison my food) if I assert myself too strongly. I am, basically, scared of everything. (I am even worried the woman giving the rTMS treatments will find this board and "punish" me for writing about her. Yep, I've thought about that many times.)
Anyway, the reason I measure my success by my personal interactions with others is because ... usually, in my day to day life, I try as much as possible to avoid interacting with others. I simply do not "extrovert" myself enough, and things often go very badly for me when I do interact with others, no matter how much I try to fight my anxiety. There is a sense inside of me (and I don't think I am wrong in a very deep way, even though it sounds irrational) that people "defeat" me, just by having more energy than I do. This is one thing that the rTMS has given me: a slight boost in energy so that I can stop ruminating about the past, and keep my energy in the present. This would be a great achievement for me if it lasted in any significant way.
And I still do not know how much I am projecting onto the young lady doing my rTMS treatments. Yes, she was trained, but there's something off with us, or at least that's my perception. I don't think she completely gets my anxiety disorder (I feel like I have to pretend nothing is wrong when I am around her or she becomes irritated), and it irritates me.
Posted by phidippus on November 21, 2014, at 14:14:10
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by mogger on November 20, 2014, at 18:16:12
Well, I just had a paradoxical reaction, one you may not have. Just know there are other anti-glutamatergic agents out there if Topomax proves unsavory for you: Rilutek, Gabapentin, Lyrica, Zonegran and Keppra. There me be others I don't know of...
Eric
Posted by SLS on November 21, 2014, at 22:44:50
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » mogger, posted by phidippus on November 21, 2014, at 14:14:10
> Well, I just had a paradoxical reaction, one you may not have. Just know there are other anti-glutamatergic agents out there if Topomax proves unsavory for you: Rilutek, Gabapentin, Lyrica, Zonegran and Keppra. There me be others I don't know of...
>
> EricMinocycline, among its many effects, is antiglutamatergic.
* NMDA modulator - mGlu autoreceptors co-agonist.
* regulation of p38 and Akt pathwaysIt has been suggested by some that a combination of Lamictal + minocycline is synergistic in the way each of them produces their antiglutamatergic effects.
A BNN report on other research regarding minocyline:
http://bipolarnews.org/wp-content/uploads/2010/05/2009.2.pdf
- Scott
Posted by mogger on November 25, 2014, at 13:14:40
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by SLS on November 21, 2014, at 22:44:50
I don't know what it is with me but some glutamate modulaters/inhibitors worsen my depression big time. Unfortunately Scott minocycline did badly as well as Gabapentin, Memantine and Tegretol. The only two that have helped my depression have been lamictal, NAC and riluzole.
Posted by phidippus on November 26, 2014, at 16:45:16
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 20, 2014, at 18:50:40
>worrying that people want to harm me (such as poison my food) if I assert myself too strongly.
This sounds almost paranoid.
>I am, basically, scared of everything.
I've been there before, but I had some paranoia going on.
>I am even worried the woman giving the rTMS treatments will find this board and "punish" me for writing about her.
More paranoia.
>things often go very badly for me when I do interact with others, no matter how much I try to fight my anxiety.
How do things go badly? Do they go badly in spite of your anxiety?
>There is a sense inside of me that people "defeat" me, just by having more energy than I do.
This 'sense', when you consider it, does it seem realistic?
>there's something off with us, or at least that's my perception.
It's hard to say if you're perception isn't colored by paranoia moreso than anxiety.
Do you take any AAPs?
Eric
Posted by Twinleaf on December 9, 2014, at 10:14:20
In reply to Re: rTMS after two weeks--Meh. Wish it weren't so. » phidippus, posted by Chris O on November 20, 2014, at 17:05:43
From your last post, it was starting to sound as though the rTMS was moderately helpful. As a veteran myself, I think it is a very benign, moderately helpful trestment which has the very valuable property of lowering chronically high cortisol levels and allowing the hippocampus to function more nearly as it does in health -producing new neurons each day.
But it is almost always a temporary trestment, increasing brain health only temporarily. You have indicated that you have some interpersonal difficulties (don't we all!). Have you had a good trial of therapy in which the relationship to the therapist is important and you can develop more intimate and satisfying ways of relating to others? Successful treatment always seems to involve both the physical and emotional aspects of anxiety and depression. I know I keep saying the same thing here, but it has really proven to be true for me!
Posted by Chris O on December 9, 2014, at 16:59:07
In reply to Re: rTMS after two weeks » Chris O, posted by Twinleaf on December 9, 2014, at 10:14:20
Thanks for checking in, Twinleaf. Well, I just did treatment 28 (out of 30) today. I'd say it's having a mild effect on my anxiety and depression, but nothing like that "I'm seeing the world clearly for the first time" experience that some people say they have. There is less enraged screaming as I try to complete my life's little daily tasks, but that I can easily be overwhelmed if I am expected to do too much. And this definitely is not getting me back into the workforce. Nope. I still feel frazzled by anxiety when asked to manage my life.
I guess I am sleeping a bit better on the nights my wife does not yell at me for not doing enough. I don't know. I have bad sleep apnea too, which gets worse the more anxious I become.
In terms of interpersonal relationships, I'd venture to say that 99% of my "issues" come from biological/physical components of my anxiety and depression. If those feelings of heaviness are ever lifted, I would say I have a decent chance of maintaining fulfilling personal relationships.
Probably my core issue from these feelings (which feels very physical to me as well) is that one of deep codependence, where I am looking to others to meet needs or do things that I should be doing for myself. This is a source of endless confusion for me (even more confusing because most people do not acknowledge or see it), and I would root it in my mother (and father) not meeting many of my core needs growing up (do to their own mental health issues). It is the source of much of my rage too.
Again, thanks for checking in. Don't have too much time to spend on writing right now. If I am lucky, my insurance will approve some more rTMS sessions and I will try the right prefrontal dorsal lateral cortex (all treatments have been on the left during this round).
Hope you are well.
Chris
Posted by b2chica on December 18, 2014, at 1:07:52
In reply to Re: rTMS after two weeks » Twinleaf, posted by Chris O on December 9, 2014, at 16:59:07
are you doing 'deep' TMS? i'm not sure what the r stands for?
anyway, i happen to have met with a psychiatrist that is involved in many studies with TMS and he was explaining a lot of it to me. its quite interesting. Anyway, he mostly does deep tms and they have the 'brainsway' systems.
do you know what systems your docs use?
-b2
Posted by Chris O on December 18, 2014, at 1:43:46
In reply to Re: rTMS after two weeks, posted by b2chica on December 18, 2014, at 1:07:52
Hi, b2chica:
Thanks for checking in with me. I am not doing deep TMS. I am doing, what I guess is now the "earlier" version of TMS, the one approved in 2010 (or thereabouts). The "r: in rTMS stands for "repetitive." I am using the Neurostar machine, the one that I think is pretty much the standard for rTMS. (The Brainsway machine seems to be the standard for deep TMS.) I am basically done with my treatment (32 treatments so far) and I can say that it is not doing much for me. I am still greatly with my anxiety symptoms and were not much of my life taken care of by my wife, I would venture to say that this treatment has done nothing for me. It's a bummer. There may be slightly more reduction in symptoms than I am admitting to, but at best, it's mild. The other thing I have noticed is that it is sometimes more difficult for me to concentrate after the treatments (and perhaps in general), but I don't know what that means. Anyway, if it hasn't hurt me in any way, I guess I'm no worse for the wear. If it has, it's another thing I can blame psychiatry for. Hope you are doing well and thanks again for responding to my posts.
Chris
Posted by b2chica on December 18, 2014, at 20:59:04
In reply to Re: rTMS after two weeks » b2chica, posted by Chris O on December 18, 2014, at 1:43:46
Thanks Chris,
from what i understand there are many variable settings for this, how deep and the location of the stimulation, along with how fast the repetitions are.
also unilateral vs. bilateral.i would say dont give up on this. but find another option, maybe clinical trials with tms.
i think tms is like other AD's in that it works Great for some and not for others. However, the pdoc i met has noticed that his method seems to work well with folks with TRD. They are doing some study now with folks with bipolar depression.
Anyway, i would say take some time but i think that there is the option of trying another place and see if they can adjust/alter settings or maybe try deep TMS- may work better?
HOWEVER< i am NOT a doc and i dont want to sound like i'm promoting this as i still am learning and dont know that much about it.
All i know is that from what i've learned i would like to see TMS used as a 'Frist line of treatment just because there does not seem to be many side effects.
i think most times get, sometimes anxiety,sometimes slight confusion or disorientation after. i think he said some people complain about the sound?i wish you ALL the Luck!
-b2
Posted by Chris O on December 19, 2014, at 9:11:04
In reply to Re: rTMS after two weeks, posted by b2chica on December 18, 2014, at 20:59:04
Thanks, b2chica!
I am still figuring out how I feel about this treatment. If it is doing as little as I think, I don't know if it should be a first line treatment. I certainly would be pissed off if I had to pay $10,000 and my current lack of improvement was the end result. And I am treatment resistant, though it's hard to say if it's more depression or anxiety or a combination of the two.
As to the side effects, I don't think there have been many. (But I'm still pondering that, too. Sometimes I feel I cannot concentrate very well due to the treatment and by that I mean it's like the treatment has somehow worsened my ability to concentrate.) The sound is not a big deal with the earplugs in. The positioning of my neck and head is a little weird, but other than that, sitting there is no big deal.
My biggest "challenge" with this treatment (if you want to call it that), is the young (somewhat controlling) woman whom my doctor has given control over the whole treatment with 30 or 40 patients in his office doing rTMS (the scheduling, operation of the machine, telling me what to do, etc.). The more I think about her and the fact that he has hardly interacted with me during the treatment, the more it annoys me. I feel like I have to be some type of therapeudic quasi confessional relationship with her due to the nature of what's going on, yet I know she doesn't "get" my situation at all. And I guess my psychiatrist doesn't either because he seems to think she's the cat's pajamas. Anyway, this is ending soon, so I won't have to think about that much longer.
Looks like it's back to the med cabinet for me after this, if I want to keep my marriage in tact and have a place to live and continue to have insurance. My wife is really getting angry about my level of dysfunction. Truly, do not know much longer I can deal with the level of humiliation I feel and the fact that so many people do not notice it, attributing my situation to "lack of willpower" or "looserness" or some other similarly upsetting thing.
And on that happy note, I wish you luck, as well.
Chris
Posted by Hugh on December 21, 2014, at 10:04:17
In reply to Re: rTMS after two weeks » Twinleaf, posted by Chris O on December 9, 2014, at 16:59:07
Did you ever try rTMS on the right side?
Posted by Chris O on December 21, 2014, at 13:18:29
In reply to Re: rTMS after two weeks » Chris O, posted by Hugh on December 21, 2014, at 10:04:17
Thanks for checking in, Hugh.
I just did the low frequency treatment on the right side for half my session last week. In truth, the right sided one pulse per second felt more relaxing (better) than the five pulse every twenty seconds on the left side, so maybe I have made a mistake doing the whole thing on the left side. My psychiatrist wanted to start bilateral treatment earlier, but, in my typical anxiety-disordered way, I resisted, so now I only have 3 treatments left, which will all be done bilaterally. Oh, well. I don't think the insurance will approve more at the time, as there current regimen seems to be 30 treatments, and 6 titrating treatments, nothing more.
Chris
This is the end of the thread.
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